乳腺黏液癌的影像学特征分析

Analysis of imaging features of mucinous breast carcinoma

目的:探讨乳腺黏液癌(MBC)的X线摄影、磁共振成像(MRI)、超声影像学特征;及三种方法在单纯型黏液癌(PMBC)和混合型黏液癌(MMBC)鉴别诊断中的价值。方法:回顾性分析2011年1月至2018年1月复旦大学附属肿瘤医院100例经手术病理证实的MBC患者共103枚病变,依据2013年版乳腺影像报告和数据系统(BI-RADS)标准,按病理结果将病变分为PMBC和MMBC两组,对病变的三种影像表现进行描述、评估和分类,分析其影像学特征及差异。结果:X线摄影示乳腺纤维腺体组织分类大部分为c类(55/76,72%);93%(71/76)病变表现为肿块:圆形、卵圆形,边缘清楚、微小分叶或模糊的高密度肿块为主;有16枚病变合并可疑恶性钙化;有8例伴同侧腋窝淋巴结肿大。MRI 72枚病变有69枚表现为肿块,T 1WI以等、高信号为主(31/72,43%;36/72,50%),T 2WI以较高信号为主(54/72,75%);边缘多为不规则和毛刺(53/69,77%);肿块强化以不均匀强化(32/69,46%)和环形强化居多(33/69,48%);时间信号强度曲线以渐进型(41/72,57%)和平台型曲线为主(24/72,33%)。DWI上呈不均匀明显高信号,其表观弥散系数(ADC)图信号略高于正常腺体。7例患者伴有皮肤增厚和乳头凹陷,8例患者伴有同侧腋窝淋巴结肿大,1例患者合并多发肺转移。超声检查74%(72/97)病变表现为不规则形肿块,以不均匀低回声为主,边界清晰,后方回声增强,彩色多普勒显示63枚病变(63/97,65%)可测及血流信号。有9例患者伴有同侧腋窝淋巴结肿大。MRI和超声显示PMBC与MMBC两组病灶边缘比较差异有统计学意义(P<0.05)。MRI显示两组病灶血供比较差异有统计学意义(P<0.05)。结论:MBC在X线、MRI及超声影像学表现具有一定的特征性,全面认识和分析其影像学特征能提高诊断正确率并有助于PMBC与MMBC的鉴别诊断。

Objective:To investigate the characteristic of mammography,magnetic resonance imaging(MRI),ultrasonography and pathology of mucinous breast carcinoma(MBC);and to study the differential diagnosis value of the three methods in pure MBC(PMBC)and mixed MBC(MMBC).Methods:One hundred and three lesions in 100 MBC patients confirmed by surgery and pathology in the Affiliated Cancer Hospital of Fudan University from January 2011 to January 2018 were retrospectively analyzed.According to the 2013 version of the breast imaging report and data system(BI-RADS)criteria,the three imaging findings of lesions were described,evaluated and classified.According to pathological results the lesions were divided into two groups,PMBC and MMBC,and their imaging features and differences were analyzed.Results:On mammography,most of the mammary glands were c-types(55/76,72%),and the lesions were mostly masses(71/76,93%),most of which were round,oval,high-density masses with circumscribed,microlobulated or indistinct margins.Suspected malignant calcification was showed in 21%(16/76)of these lesions.Eight patients had ipsilateral axillary lymphadenopathy.On MRI,most lesions showed masses(69/72,96%).Sixty-seven lesions(31/72,43%;36/72,50%)showed equal and high signals on T 1WI,and 54 lesions(54/72,75%)showed higher signals on T 2WI.The margins were mostly irregular and burrs(53/69,77%).Masses enhancement was dominated by heterogeneous enhancement(32/69,46%)and rim enhancement(33/69,48%).The patter of time-signal intensity was dominated by progressive curves(41/72,57%)and platform curves(24/72,33%).The lesions had heterogeneous high signal on DWI.The ADC signal was slightly higher than normal gland.Seven patients were accompanied with thickening of the skin and nipple retraction.Eight patients had ipsilateral axillary lymphadenopathy.One patient had multiple lung metastases.On ultrasonography,most lesions showed irregular masses,heterogeneous hypoechoic,well-defined margins,posterior echo enhancement(75/97,77%).Color Doppler imaging showed vascularity in 65%(63/97)of these lesions.Nine patients had ipsilateral axillary lymphadenopathy.There was significant difference in margins between PMBC and MMBC(P<0.05)on MRI and ultrasonography.It showed significant difference in vascularity between 2 groups(P<0.05)on MRI.Conclusions:MBC has some typical features in mammography,MRI and ultrasonography.Realizing its features can improve the diagnostic accuracy of MBC,and it also can contribute to the differential diagnosis of PMBC and MMBC.